lupus Flashcards
anti-dsDNA
high titers are SLE-specific and in some patients correlate with disease activity, nephritis, vasculitis
anti-Sm
specific for SLE, no definite clinical correlations; most pts also have anti-RNP, more common in blacks and asians than whites
anti-histone
more frequent in drug-induced lupus than in SLE
anti-phospholipid
three tests available: ELISAs or cardiolipin and B2G1, sensitive prothrombin time; predisposes to clotting, fetal loss, thrombocytopenia
diagnostic criteria for lupus
malar rash,, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disorder, neurologic disorder, hematologic disorder, immunologic disorder, anti-nuclear antibiotics
if >= 4, specificity is 95%
MSK manifestations of SLE
arthralgias/myalgias, nonerosive polyarthritis, hand deforrmities, myopathy/myositis, ischemic necrosis of bone
cutaneous manifestations of lupus
photosensitivity, malar rash, oral ulcers, alopecia, discoid rash, vasculitis rash
renal manifestations of lupus
nephritis usually most serious (nephritis + infection leading causes of mortality)
- proteinuria, hematuria, diffuse proliferative glomerulonephritis (DPGN)
- nephrotic syndrome, HTN
what to do when someone is diagnosed with lupus
UA
renal biopsy to plan current and future therapies
neurologic manifestations of lupus
cognitive disorder, mood disorder, headache, seizures, mono or polyneuropathy, stroke / TIA, acute confusional state or movement disorder, aseptic meningitis, myelopathy
for neurologic symptoms caused by lupus, what needs to be figured out?
if symptoms are caused by a diffuse process (requiring immunosuppression) r vascular occlusive disease (requiring anticoagulation)
ANA
best screening test for SLE; repeated negative tests make SLE unlikely
vascular manifestations of lupus
increased TIA, stroke, and MI
anti-phospholipid ass. w/ hypercoaguability and acute thrombotic events
chronic disease w/ accelerated atherosclerosis
how can a lupus pt get brain ischemia?
focal occlusion (either noninflammatory or ass. w/ vasculitis) or by embolization from carotid artery plaque or from fibrinous veggies of Libman-Sacks endocarditis
how to treat vascular event in lupus?
if likely from clotting, use long term anticoagulation
if both vasculitis and vascular occlusion, anticoagulation and immunosuppression
pulmonary manifestations of lupus
pleuritis w/ or w/o pleural effusion (usually responds to NSAIDs and steroids)
also, pulmonary infiltrates, interstitial inflammation leading to fibrosis, shrinking lung sundrome, and intra-alveolar hemorrhage
cardiac manifestations of lupus
pericarditis
also, myocarditis and fibrinous endocarditis of Libman-Sacks –> valvular insufficiencies
MI
hematologic manifestations of lupus
anemia of chronic disease
hemolytic anemia, leukopenia and thrombocytopenia all responsive to steroids
GI manifestations of lupus
flare –> n/v/d
autoimmune peritonitis
intestinal vasculitis can lead to perforations, ischemia, bleeding and sepsis
ocular manifestations of lupus
sicca syndrome / Sjögren’s syndrome
conjunctivitis
serious: retinal vasculitis and optic neuritis
tests for following lupus disease course
UA (hematuria, proteinuria), hemoglobin, platelets, creatinine, albumin
conservative therapies for mgmt of non-life threatening lupus
analgesics and antimalarials
analgesics = usually NSAIDs
antimalarials = hydroxychloroquine, chloroquine, and quinacrine
if inadequate: may add steroids, mycophenolate mofetil, belimumab, azathioprine, methotrexate
how to manage dermatitis from lupus
topical sunscreen, anti-malarials, and topical steroids and/or tacrolimus
mgmt for life-threatening lupus (proliferative forms of lupus nephritis)
steroids + either cyclophosphamide or mycophenolate mofetil, perhaps also azathioprine
pulmonary manifestations of lupus
pleuritis w/ or w/o pleural effusion (usually responds to NSAIDs and steroids)
also, pulmonary infiltrates, interstitial inflammation leading to fibrosis, shrinking lung sundrome, and intra-alveolar hemorrhage
cardiac manifestations of lupus
pericarditis
also, myocarditis and fibrinous endocarditis of Libman-Sacks –> valvular insufficiencies
MI
hematologic manifestations of lupus
anemia of chronic disease
hemolytic anemia, leukopenia and thrombocytopenia all responsive to steroids
GI manifestations of lupus
flare –> n/v/d
autoimmune peritonitis
intestinal vasculitis can lead to perforations, ischemia, bleeding and sepsis
ocular manifestations of lupus
sicca syndrome / Sjögren’s syndrome
conjunctivitis
serious: retinal vasculitis and optic neuritis
tests for following lupus disease course
UA (hematuria, proteinuria), hemoglobin, platelets, creatinine, albumin
conservative therapies for mgmt of non-life threatening lupus
analgesics and antimalarials
analgesics = usually NSAIDs
antimalarials = hydroxychloroquine, chloroquine, and quinacrine
if inadequate: may add steroids, mycophenolate mofetil, belimumab, azathioprine, methotrexate
how to manage dermatitis from lupus
topical sunscreen, anti-malarials, and topical steroids and/or tacrolimus
mgmt for life-threatening lupus (proliferative forms of lupus nephritis)
steroids + either cyclophosphamide or mycophenolate mofetil, perhaps also azathioprine
